Thanthilimale Social Survey

A long-term social survey in a CKDu affected area was performed to get a better understanding of the dynamics between water usage and acquisition of the disease. The target was to see where the disease was most prevalent, learn about how people used water and pesticides (and other possible factors) and identify water sampling locations for future study. Information on residents’ pesticide usage habits, water sources and medical histories were acquired using a survey format. Some interesting correlations were seen, but more analyses are needed before conclusion can be drawn.

About Thanthilimale

Thanthilimale is a small town northwest of Anuradhapura. It is famous for its temple, which is located on a rocky outcrop, stone carvings and bodhi tree (supposedly one of the oldest in Sri Lanka). Directly to the west lies Willapattu National Park and lots of wildlife overflows into the town.

Stone carvings on the temple ground

My room!

Thanthilimale Temple

The surrounding landscape

Hard at work?

Current Situation

The National Water Supply and Drainage Board delivers water to people of the affected area by tanker. This is very time and fuel consuming. Up to three families share a tank, which is filled twice a month, for drinking and cooking only. There are over 300 tanks to fill!

Water delivery by tanker.

Historically, the local population depended on human-made reservoirs and dug wells to meet their water needs. There is a rich and advanced culture of reservoirs and irrigation that goes back 1000 years in Sri Lanka. Many of them remain in use today for irrigation. Drinking water demands are mostly met by wells throughout the country. Rain water collection is also sometimes used. Unfortunately, many of the wells in the area have been determined to be “unfit for drinking” by various organizations. Thus, the Water Board delivers water, until a more permanent solution to the issue can be found.

Typical rainwater collection tank

Typical well

Drought

Many people complained about the severe drought this year. Although drinking water is supplied by the Water Board, many had no water for washing or toilets. And if the delivered water ran out (which many people had) they literally had no water. This was a very serious problem on very one’s mind as I went around doing the interviews. The lack of rain was also severely affecting local crops.

Waterless well

Drought affecting crops. Corn is usually head high, almost ready to harvest this time of year (November).

Daily Life

Usually living in Colombo, time in Thanthilimale was refreshing and eye-opening at the same time. There are definitely less amenities here, making dependence on others crucial for physical and social well-being. I would visit a house and be well into my interview before realizing that the person I was talking to did not actually live there. He/she was actually a sister or the owner’s husband’s cousin, or just a neighbor etc. And the children running around were not theirs but their nephews, or their nephew’s kids etc. People lived not in houses, but in the communities in which they were rooted and shared everything (including houses and parents and grandparents!). It is a good thing that Colombo lacks.

Typical house. You never knew if the person you were interviewing actually lived there, or was a sister/neighbor/wife’s cousin etc. Notice the Solar Panels on the roof. Only source of power in many households.

Data entry during the almost nightly power outages. At least I didn’t have to worry about turning off the lights before going to bed!

Making dinner! (and breakfast and lunch…)

Friends at the temple.

Smile!

Current Issues

The prevalence of CKDu and suspicion of water as a cause is not new in Thanthilimale or other areas of Sri Lanka. Many organizations (Governmental, Non-governmental, international, academic etc) have attempted to find the cause, but most have failed. Thanthilimale has been visited before by these organizations. Public Health inspectors, local doctors, National health departments, the WHO, and NGOs such as PLAN Sri Lanka have all visited, sampled the water, given their conclusions and left. During the interviewing process, I found that many families were told their well water was not fit to drink due to “High Hardness.” When asked who gave this order, the answer was usually one of three: 1) The local Public Health Inspector, 2) PLAN Sri Lanka or 3) I don’t remember. Records of the testing and results are proving very difficult to track down. This information is vital to determine the actual hardness levels that constituted “high hardness.” Knowing this also allows us to know one more thing: what levels were considered “safe to drink” and therefore, people continue to drink today. And now, we are essentially there doing the same thing, testing again and leaving bad records. The whole thing reminds me of a XKCDcartoon. But swear, what we are trying to do is really different this time. We are going after pesticides in the water! Not just hardness.

Abandoned PLAN Sri Lanka water supply scheme

Next Steps

With the Social Survey results in hand, the next step is to determine vital sampling points. About a dozen or so wells will be chosen to regularly sample and test for pesticides and try to correlate the results with incidents of CKDu.

The u stands for “unknown etiology.” Because kidney disease is commonly caused by high blood pressure and diabetes. These people don’t have that, and no one knows the cause. I’ve even seen it called CKDmfo lately…multifactoral origin. Fancyね…

I don’t know if I can actually improve people’s health conditions through my work. It’s debatable whether this is even the Water Board’s job…it seems like a public health issue. But, there certainly are things that the Water Board can and should do in terms of analysis and increasing technical capabilities to understand people’s water situations.